Amputation above elbow/knee refers to a surgical procedure where the limb is removed at a level higher than the elbow or knee joint. This type of amputation is typically performed when there is severe trauma, advanced disease, or irreparable damage to the limb that extends beyond the joint itself. The goal of such an amputation is to remove the affected limb while preserving as much functional length and mobility as possible for prosthetic fitting and rehabilitation.

Indications for Above-Elbow or Above-Knee Amputation

1. Severe Trauma:

• Irreversible damage to the limb due to accidents, crush injuries, or severe fractures that cannot be reconstructed.
• Severe arterial or venous disease affecting blood flow to the limb, leading to tissue death (gangrene) or non-healing ulcers.
• Malignant tumors affecting the bone or soft tissues of the limb, where amputation is necessary for disease control.
• Severe infections such as osteomyelitis (bone infection) or necrotizing fasciitis (flesh-eating bacteria) that do not respond to antibiotics and threaten the limb and life.
• Rare congenital conditions affecting limb development or function that may require surgical intervention.
• Advanced arthritis or joint destruction that severely limits mobility and causes chronic pain.

1. Peripheral Vascular Disease:
2. Cancer:
3. Infection:
4. Congenital Abnormalities:
5. Severe Arthritis:

Procedure Overview

1. Preoperative Evaluation:

• Comprehensive assessment including physical examination, imaging studies (X-rays, CT scans), and laboratory tests to evaluate the extent of the condition and overall health of the patient.
• The procedure is typically performed under general anesthesia to ensure the patient is unconscious and pain-free throughout the surgery.
• Incision and Dissection:
  • An incision is made at the predetermined level above the elbow or knee joint.
  • Skin, muscles, blood vessels, and nerves are carefully dissected and prepared for resection.
  • Bone Cutting:
    • The bone (humerus or femur) is cut using specialized saws, ensuring clean and precise cuts.
  • Closure:
    • The remaining skin and soft tissues are shaped and closed over the amputation site to create a functional and aesthetically acceptable stump.
  • Dressing:
    • The wound is dressed to promote healing and prevent infection.
  • Pain management with medications.
  • Monitoring for signs of complications such as infection, excessive bleeding, or poor wound healing.
  • Rehabilitation planning to optimize function and adaptation.

1. Anesthesia:
2. Surgical Technique:
3. Postoperative Care:

Rehabilitation

1. Physical Therapy:

• Exercises to strengthen the remaining muscles, improve mobility, and prepare for prosthetic fitting.
• Training in activities of daily living and use of adaptive devices or prosthetics.
• Once the stump has healed and rehabilitation progresses, fitting for a prosthetic limb may be initiated to restore function and mobility.

1. Occupational Therapy:
2. Prosthetic Fitting:

Advantages of Above-Elbow or Above-Knee Amputation

1. Pain Relief:

• Removal of the diseased or severely injured limb can alleviate chronic pain and discomfort.
• Prevents the spread of infection to other parts of the body.
• Reduces disability associated with severe conditions affecting the limb, allowing for better mobility and independence.
• Provides a functional stump length for effective prosthetic fitting and use.

1. Infection Control:
2. Improved Quality of Life:
3. Potential for Prosthetic Use:

Disadvantages of Above-Elbow or Above-Knee Amputation

1. Loss of Function:

• Permanent loss of the limb above the elbow or knee joint, leading to decreased function and mobility.
• Significant emotional and psychological adjustment required for patients and their families.
• Longer rehabilitation period and adaptation to activities of daily living.
• Risks associated with any surgical procedure, including infection, bleeding, and wound healing issues.

1. Psychological Impact:
2. Rehabilitation Challenges:
3. Potential Complications:

Considerations

• Patient's Overall Health:
  • General health status and presence of comorbid conditions influencing surgical outcomes.
• Functional Goals:
  • Tailoring rehabilitation and prosthetic options to meet the patient's functional needs and goals.
• Long-Term Care:
  • Monitoring for potential complications and long-term management of residual symptoms.

Disclaimer

The information provided here is intended for general informational purposes only and should not be construed as medical advice. Above-elbow or above-knee amputation is a complex surgical procedure that should only be performed by qualified healthcare professionals. The necessity and appropriateness of the procedure vary based on individual patient circumstances, and a licensed healthcare provider should be consulted to determine the best course of action for your specific situation.